Healthcare Provider Details

I. General information

NPI: 1699139576
Provider Name (Legal Business Name): ALLYSA PRASHAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MIDDLE SETTLEMENT RD
NEW HARTFORD NY
13413-5331
US

IV. Provider business mailing address

2209 GENESEE STREET BUSINESS OFFICE
UTICA NY
13501
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-8500
  • Fax: 315-624-8515
Mailing address:
  • Phone: 315-801-4238
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number300470
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: